Clinical Psychology

BIBLIOGRAPHY

Clinical psychology, a branch of psychology, is that body of knowledge and skills which can be used to help persons with behavior disabilities or mental disorders to achieve better adjustment and self-expression. It encompasses the applied areas of diagnosis, treatment, and prevention, as well as the basic area of research. (In British countries the term “clinical psychology” is more or less interchangeable with “medical psychology.”)

In function, clinical psychology overlaps a number of fields. The profession to which it is most closely related is psychiatry. Psychiatrists, although members of a medical specialty whose training includes medical school, general internship,and three years of psychiatric residency, have more in common with clinical psychologists than with other physicians. Because of their medical training, however, psychiatrists, unlike clinical psychologists, can use drugs. Psychotherapy as a major treatment technique and diagnosis are areas common to both clinical psychology and psychiatry, although the two professions make use of somewhat different approaches.

Psychiatry tends to use interviews and mentalstatus examinations, whereas psychology leans more to objective tests and projective devices. Both groups are increasingly directing attention to the rapidly expanding area of prevention. Clinical psychologists have generally been more active in research than psychiatrists, but a marked effort is being made to increase the number of psychiatrists participating in research activities. Clinical psychology also has much in common with social work, particularly in the area of treatment. Social workers are given excellent training in this function— perhaps better training than either of the other two major mental health professionals, clinical psychologists or psychiatrists. Social work has in recent years recognized the weakness of being a profession that has neither an underlying basic discipline nor a body of research, and it is attempting to remedy these difficulties. Clinical psychology borders on the fields of sociology, particularly in its social-psychological aspects, and the ministry, when the latter assumes the “helping” role. Clinical psychology’s relation to anthropology is remote except for the analogies that may be drawn between patterns of collective behavior and forms of individual pathology.

The content of clinical psychology includes large portions of psychopathology, abnormal psychology, and similar areas. It is particularly dependent on personality theory and psychoanalysis for its theoretical underpinnings.

Origins. Clinical psychology is younger than many other branches of psychology. In an organized form it dates from 1896, when Lightner Witmer first established a psychological clinic at the University of Pennsylvania. (Witmer also coined the terms “clinical psychology,” “psychological clinic,” and “orthogenics.”) From the beginning he called for the qualitative study of the individual patient, for therapeutic as well as diagnostic purposes. He acknowledged the need for the detailed consideration and prolonged observation of cases by establishing a children’s hospital–school. Although in its early period the clinic was concerned almost entirely with the retarded child, in later years its major preoccupations were the problems of the superior child, vocational guidance, and speech disability. What has since become known as the “team” approach—coordinated work by representatives of a number of disciplines dealing with the same case—was, after a fashion, adopted at an early date by the clinic. Physicians, especially neurologists, and social workers collaborated on case studies. Witmer emphasized the need for professional training and developed a pattern of attack that included most of the elements of present-day clinics.

While Witmer’s clinic was expanding its activities, the Binet movement in France was gathering force. Rumblings of it had been heard at the turn of the century, and with the publication of the Binet-Simon test in 1905 the potential of the intelligence test first became evident. The Vineland Training School, an institution for the mentally retarded, was among the first to adapt the test to American conditions. There, in 1906, H. H. Goddard started the first American psychological laboratory.

About 1910, a second university clinic, modeled on Witmer’s was organized by Carl Seashore at the University of Iowa. During the same period, J. E. Wallace Wallin began to apply psychological techniques to school children. He started a psychoeducational clinic at the University of Pittsburgh in 1912. Emphasizing the educational, as opposed to the psychopathological significance of clinics, Wallin recommended that clinics be established in association with departments of education rather than with psychology departments.

In the latter part of the nineteenth century and through the early part of the twentieth, the activities of such men as J. M. Charcot and Pierre Janet —but most particularly Sigmund Freud, abroad, and Adolf Meyer in this country—brought prominence to the functional point of view. Their influence led to the development of perhaps the most important type of clinic in this country.

In 1909, in association with the Cook County Juvenile Court of Chicago, William Healy started a behavior clinic. It is from this event that the child-guidance movement dates its origin. Although impressed by Witmer’s clinic, Healy, who was concerned mainly with social pathology, took a different approach. Despite Witmer’s pioneering, Healy’s approach was to have a greater and more lasting effect on clinical psychology specifically and on the field of mental hygiene in general.

Witmer versus Healy. Why this difference? Study of the programs of the two clinics shows Witmer’s strikingly consistent concern with educational problems, primarily with those of the mentally retarded. His emphasis on the intellectualcognitive aspects of personality naturally led to contact with educators in school settings or in institutions for the mentally retarded. When interested in a medical problem, Witmer focused on its physical or neurological aspects. Healy, on the other hand, emphasized the affective aspects of personality, looked at the psychiatric side of medical problems, and dealt with a variety of social agencies and institutions. Healy, it turns out, was wiser in his choice, for the study of the mentally retarded has remained relatively more narrow and distinctly less rewarding than the study of the personality differences associated with psychopathy, neurosis, or psychosis. Events such as those reflected in the mental health bills passed by Congress in 1963 may belie this statement, but professionals treating or doing research in mental disorder, with few exceptions, hold to it. [SeeMental retardation.]

The lack of organized information flowing from the Pennsylvania clinic also served to circumscribe the response to the Witmer approach. Witmer never published a systematic book on the clinical field; his major contributions were papers in his own journal. Holmes’s book (1912) describing the clinic’s procedure is rather anemic and unimaginative. In contrast, Healy’s The Individual Delinquent (1915) is a rounded and challenging work.

The structure of the Pennsylvania clinic may have created additional obstacles to its influence. Because it was established in a university setting and was directed by a nonphysician, the clinic may have been effectively barred from social prominence. Association with student training may have limited its scope. Had the clinic been established in a medical school already recognized as a therapeutic center, or in a market place of social agencies (as Healy’s clinic was), it might have had more general influence. Or perhaps Witmer was ahead of the times.

More important than the content of the programs, the way information was disseminated, or the characteristics of the clinics (or perhaps inextricably woven into all) were the outlooks of the respective leaders. Whereas Witmer’s approach was essentially segmental and static, relatively uninspiring and plodding, Healy’s was total, seminal, and stimulating. Whereas Healy was markedly influenced by the functional psychology of James and the dynamic views of Freud and Meyer, Witmer identified with the less imaginative WundtianKraepelinian approach. A systematic skimming of Psychological Clinic, the journal Witmer founded, leaves one with the feeling that Witmer was burdened by a conservatism which led him to oppose dynamic psychology because it was “unscientific” and “radical.” This attitude is paradoxical for a pioneer. Witmer’s pioneering, however, was not really in new thinking but rather in new material to which old thinking was applied. Healy’s perspective, in comparison, was to prove more suited to the developing field of clinical psychology.

Early developments. Paralleling the growth of the clinics was the establishment of psychological laboratories in hospitals for the mentally disordered. The McLean Hospital, St. Elizabeth’s Hospital, and the Boston Psychopathic Hospital were outstanding. In some respects the work in the hospital laboratories followed conservative academic–experimental lines. In other ways hospital activities promoted the liberal use of test devices.

Since the earliest days of clinical psychology, the American Psychological Association has made attempts to deal with problems related to the field (Fernberger 1932, pp. 42–53). Since 1895 it has taken an interest in the standardization of mental tests. In 1915 a study of the qualifications of mental examiners was initiated. In 1918 a committee appointed to explore the problem reported in favor of the certification of examiners by the association. A certifying committee was appointed in 1920, but by 1923 only 25 members had applied for certification, and in 1927 certification was discontinued. It was started again, however, in 1947.

During the 1930s various systematic efforts were made to deal with clinical psychological problems. Morrow (1946) has described the attempts of university, state, and national organizations to devise standards of training and experience.

In the early 1940s a considerable amount of clinical work was being done in communities and hospitals, as well as in universities (which had, however, taken a decidedly secondary role), by psychologists whose training was, with few exceptions, unsystematically acquired. Although there was wide concern with problems of training, few organized programs had been set up. Whatever background the clinical psychologist had was largely self-determined. His training was surprisingly uninfluenced by programs emanating from universities or other recognized psychological institutions.

Recent developments. Since the 1940s there has been considerable preoccupation with the problems of clinical psychology. The play of a great variety of forces, both within and without psychology, has made clinical psychology into a field that calls upon its practitioners for competence in three major tasks: (1) diagnosis, or the acquisition of knowledge about the origin and nature of existing psychological conditions through the use of tests, measurements, standard interviews, and similar procedures; (2) research, or the advancement of knowledge by a systematic attack, in the laboratory or in the field setting, on specific problems capable of controlled, experimental resolution; and (3) therapy, or the intricate art and science of improving the condition of clients. Beyond these tasks lies always—implicitly at least, but increasingly at an explicit level—the important problem of prevention.

In the 1960s, doctoral training for these tasks calls for a minimum program of four years, one year of which (preferably the third) consists of an internship. Practica, clerkships, and internships are organized on a foundation of basic courses in theoretical, clinical, and dynamic psychology. The type of training program now generally accepted was initially proposed by the Committee on Training in Clinical Psychology of the American Psychological Association in its 1947 report and was further supported in conferences at Boulder (Conference… 1950), Stanford (Strother 1956), Miami (Conference… 1959), and Chicago (Hoch et al. 1966). The 1947 report recommended that clinical training be centered in existing university departments and that field-training units be integrated with university programs. Although proposals have been made for the establishment of special professional schools in clinical psychology, the solution still generally favored is the expansion of existing university psychology departments to meet the needs of clinical psychology. Such a plan underscores the model of the clinical psychologist as a scientist-professional and supports the motto “A clinical psychologist is a psychologist first and a clinician second.”

As the professional consciousness of psychologists has developed, however, universities and field centers have come to recognize the importance of appropriate personality qualities and high intellectual abilities in clinical work. In the past, some professors had a tendency to direct their weaker students—those who did not have the makings of “scientists”—into clinical courses with the hope that they would then be able to find jobs in clinical settings. A number of poorly trained people, generally called “psychometricians,” who presumably were nothing more than psychological technicians, thus entered the field. The present attention to selection and recruitment problems, however, has led to an increase in competently trained researchers and practitioners. Most have come from institutions in which standards have been maintained and a reasonably comfortable relationship exists between academic and clinical psychology. Some have also come from centers where the standards have not been of the highest level, but where exceptionally good people have managed, in one way or another, to educate themselves.

The American Psychological Association has, in recent years, taken an increasingly greater role in setting up standards for evaluating both training and practice in clinical psychology. The Committee on Graduate and Professional Training (American Psychological Association 1945) was followed by the Committees on Training in Clinical Psychology (American Psychological Association 1947; 1948; 1949) and more recently by the Education and Training Board (Conference… 1959). These committees have provided the criteria for approving universities and for recommending their participation in programs of the Veterans Administration and the Public Health Service (Ross 1964; 1965; Ross & Lockman 1964; Goodstein & Ross 1966).

To consolidate and advance standards, the American Board of Examiners in Professional Psychology was organized and, in April 1947, incorporated. It was modeled on the specialty boards in medicine and had similar standards. The board generally requires five years of acceptable experience, in addition to the doctoral degree, for admission to the examination for a diploma. A “grandfather clause,” which expired December 31, 1949, allowed for certification of qualified persons on the basis of experience rather than actual examination.

With the protection of the public in mind, governmental bodies have made several attempts to set the standards for the certification of psychologists. The two types of legislation that have been under consideration by state agencies are exemplified, in their essentials, by the early laws of Connecticut and Virginia. The Connecticut law provides for the general certification of psychologists with a ph.d. degree plus one year of experience; the Virginia law entails the certification of specified kinds of psychologists with a ph.d. plus five years of experience. The consensus among psychologists is that state certification should follow the Connecticut pattern and that “expert” certification should be left to a professional agency, such as the American Board of Examiners in Professional Psychology.

Present picture. Since 1947, the growth of clinical psychology in the United States has been phenomenal. This is reflected, to a small degree, in the following statistics: (1) membership in the Division of Clinical Psychology of the American Psychological Association has risen from 787 in 1948 to 3,048 in 1966; (2) the number of schools fully approved by the Committee on Training in Clinical Psychology of the American Psychological Association has increased from 20 in 1948 to 67 in 1965; (3) there were an estimated 742 graduate students enrolled in doctoral-training programs in clinical psychology in the academic year 1947/1948 compared to 3,340 in 1962/1963; (4) the number of clinical psychologists certified by the American Board of Examiners in Professional Psychology has increased from 234 in 1948 to 1,793 in 1963 (of the total, 1,116 are “grandfathers”); (5) some form of statutory control has been established by 28 states and four Canadian provinces, and non-statutory control has been set up by 18 states.

But this unusual growth has not come about without much travail. An increasing number of questions have arisen which psychology and clinical psychology will have to answer in the coming years: (1) Can psychologists be trained who have both professional and scientific goals in mind? (2) How much application can there be in a field in which basic knowledge is still so meager? (3) Should clinical psychologists devote more time to research? (4) How can socially unprofitable trends toward private practice be curbed? (5) Should training for research and teaching be separated from training for the applications of psychology? (Shakow 1965).

Outside the United States there are signs of increasing interest in clinical psychology (David 1958). Growth rates for the countries differ, however, and the pace is decidedly less rapid outside the United States.

England and Canada. In Britain, the pattern has, in general, been less structured than in the United States. Formal programs, where they do exist, have been modeled on the Maudsley (University of London) pattern, which consists of one to two years of practical experience and a doctoral dissertation. The development of the National Health Service in 1948 led to an increase of clinical psychologists (Summerfield 1958). Whereas at the end of 1945 there were 77 professional psychologists in the British Psychological Society working in mental health, by 1958 the number had increased to some 400. University training facilities have been extended and the pursuit of higher degrees has been encouraged. In English-speaking Canadian universities, training has consisted of a combination of American and English patterns, generally calling for a diploma or special master’s degree after one to two years of practical training, followed by two years of formal research leading to the PH.D. The report on the Conference on the Training of Professional Psychologists, held in May 1965 at the Couchiching Conference Center at Geneva Park, Ontario (Coons 1965), presents a detailed discussion of developments in Canada.

Western Europe. The situation in the western Continental countries is not as encouraging. A strong medical tradition still holds sway, limiting a good deal of the practice of clinical psychology (and particularly of psychotherapy) to physicians. In the last few years, however, these countries have made increasing inquiries about American training programs, and one can expect some growth of clinical training along American lines.

Eastern Europe. In eastern continental Europe, medical influence is even more pervasive. Particular emphasis is placed upon physiological functioning with a corresponding denigration of the place of psychological testing, objective or subjective, and of the study of individual differences generally. Rapid growth of clinical psychology appears less likely.

Japan. In Japan, noteworthy among Eastern countries, psychology is in an active ferment (McGinnies 1960). The field of clinical psychology is developing rapidly despite a number of handicaps—for instance, the rigidity of the university system and the overrepresentation of physicians in the field. Thus, at the 1958 meeting of the Japanese Psychological Association, of the 619 papers presented, representing 11 areas, clinical psychology ranked fourth in number, being preceded only by perception, education, and learning.

Problems and prospects. On the whole there has been a tremendous growth of clinical psychology in the United States and a moderate growth, along similar lines, in other countries. The hope is that countries will work out patterns suited to their own needs and not be guided too much by the patterns established in the United States—patterns that have brought with them problems of their own. A large number of major problems must be solved by both psychology and clinical psychology if clinical psychology is to make its proper contribution to the needs of society and to develop its potential as a profession. These include training both for old and new areas of endeavor, evaluation of both training institutions and individuals, and improvement of existing programs. Specifically, the following issues have to be faced.

Training for research. The role of the university, the role of the field center, and the relationship between the two types of institutions need elaboration. Concomitantly, the content of research needs redefinition so it will encompass the most rigorous laboratory research, systematic naturalistic observation, and a serious attitude of inquiry leading to deliberate efforts to answer questions that arise during clinical operations.

Application. The function of each of the training agencies and the way to integrate their work in institutional and community settings need clarification.

Areas for research and practice. Much imaginative thinking is demanded. New methods of therapy, new methods of diagnosis, and, particularly, preventive methods of education are becoming increasingly important. Clinical psychology must do everything it can to attract persons with the resourcefulness to meet problems in unconventional areas. It is clear that the personnel shortages in the area of mental health will be enormous. Much thought and experimentation must go into making use of a larger pool of persons, for example, younger persons with the ideals and resourcefulness represented in Peace Corps volunteers, older persons such as mothers whose children no longer need their attention (see the experiment by Margaret Rioch et al. 1963), and teachers whose effective use is crucial in the mental health area. In addition, new methods of therapy and prevention must be constantly invented for, and tested on, groups—especially the underprivileged—that have heretofore received little consideration in mental health projects.

University training programs. The proper university settings for training in clinical psychology should be described and the importance of programs coming from unified departments considered. The nature of the doctoral degree granted to clinical psychologists—whether strictly professional (say, a ps.d.) or a combined research degree (the ph.d.)—calls for special discussion. The place and nature of postdoctoral programs, especially such programs for psychotherapy training, should be given equal thought.

Evaluation and regulation. There should be a re-examination of the composition, responsibilities, and standards of those committees that evaluate the performance of institutions, both universities and field centers, and those that regulate the activities of individuals, such as the American Board of Examiners in Professional Psychology and state licensing and certification boards.

Upgrading research and practice. Periodic regional conferences to consider the details of existing and potential training programs would be an effort in the direction of upgrading research and practice. The kind of professional eclecticism proposed by Kubie (1954) or the intensive, integrated approach discussed in detail at the Gould House Conference on an Ideal Program of Training for Psychotherapists (1963) may be possibilities. In addition, methods for making the private practice of psychology more effective and socially useful should be reviewed.

The major problems of clinical psychology continue to lie within the parent field, psychology. Clinical psychology, after a long period spent as part of an academic discipline, has been through the early stages of becoming a profession as well. It is going through the natural disturbances and difficulties that attend a growth process of this kind. These need not be of serious concern, however, if clinical psychology selects its students carefully, for personality as well as intellect; if it trains thoroughly, in spirit as well as letter; if it trains broadly, recognizing that narrowly educated specialists are not true clinical psychologists; if it remains flexible about its training and encourages experimentation; if it does not sacrifice more remote goals to the fulfillment of immediate needs; if it maintains its contact with its scientific background, remaining alert to the importance of theory as well as practice; if it keeps modest in the face of the complexity of its problems, rather than becoming pretentious—in short, if it finds good people and gives them good training its future in society and as a profession is then assured.

David Shakow

[Directly related are the entriesCounseling psychology; Mental disorders, treatment of, article onPsychological treatment; Psychiatry. Other relevant material may be found inMental health; Psychoanalysis; Social work; and in the biographies ofMeyerandSeashore.]

BIBLIOGRAPHY

American Psychological Association, Committee on Training in Clinical Psychology 1947 Recommended Graduate Training Program in Clinical Psychology. American Psychologist 2:539–558. → Reprinted in 1950 in Conference on Graduate Education in Clinical Psychology, University of Colorado, 1949, Training in Clinical Psychology.

American Psychological Association, Committee on Training in Clinical Psychology 1948 Clinical Training Facilities: 1948. American Psychologist 3: 317–318.

American Psychological Association, Committee on Training in Clinical Psychology 1949 Doctoral Training Programs in Clinical Psychology. American Psychologist 4:331–341.

AmericanPsychological Association-ThE American Association for Applied Psychology, Committees on Graduate and Professional Training, Subcommittee on Graduate Internship Training 1945 Graduate Internship Training in Psychology. Journal of Consulting Psychology 9:243–266.

Conference on an Ideal Program of Training for Psychotherapists, Gould House, Ardsley-on-Hudson, N.Y. 1963 Proceedings. Unpublished manuscript.

Conference on Graduate Education in Clinical Psychology, University of Colorado, 1949 1950 Training in Clinical Psychology. Edited by Victor Raimy. Englewood Cliffs, N.J.: Prentice-Hall.

Conference on Graduate Education inPsychology, Miami Beach, 1958 1959 Graduate Education in Psychology: Report. Washington: American Psychological Association.

Coons, W. H. 1965 The Conference on the Training of Professional Psychologists. Canadian Psychologist 6a: 155–156.

David, Henry P. 1958 Clinical Psychology in Other Lands. Progress in Clinical Psychology 3:235–247.

Fernberger, Samuel W. 1932 The American Psychological Association: A Historical Survey, 1892–1930. Psychological Bulletin 29:1–89.

Goodstein, Leonard D.; and Ross, Sherman 1966 Accreditation of Graduate Programs in Psychology: An Analysis. American Psychologist 21:218–223.

Healy, William1915 The Individual Delinquent: A Text-book of Diagnosis and Prognosis for All Concerned in Understanding Offenders. Boston: Little.

Hoch, Erasmus L.; Ros, Alan O.; and Winder, C. L. 1966 Conference on the Professional Preparation of Clinical Psychologists: A Summary. American Psychologist 21:42–51.

Holmes, Arthur 1912 The Conservation of the Child. Philadelphia: Lippincott.

Kubie, Lawrence S. 1954 The Pros and Cons of a New Profession: A Doctorate in Medical Psychology. Texas Reports on Biology and Medicine 12:692–737.

Mcginnies, Elliott 1960 Psychology in Japan: 1960. American Psychologist 15:556–562.

Morrow, William R. 1946 The Development of Psychological Internship Training. Journal of Consulting Psychology 10:165–183.

Rioch, Margaret J. et al. 1963 National Institute of Mental Health Pilot Study in Training Mental Health Counselors. American Journal of Orthopsychiatry 33: 678–689.

Ross, Sherman1964 Internships for Doctoral Training in Clinical Psychology Approved by the American Psychological Association. American Psychologist 19: 809–811.

Ross, Sherman 1965 APA-approved Doctoral Programs in Clinical and in Counseling Psychology: 1965. American Psychologist 20:794–795.

Ross, Sherman; and Lockman, Robert F. 1964 Survey of Graduate Education in Psychology: Some Trends for the Last Decade. American Psychologist 19:623–628.

Shakow, David 1965 Clinical Psychology in Light of the 1947 Committee on Training in Clinical Psychology Report. American Psychologist 20:353–362.

Strother, Charles (editor) 1956 Psychology and Mental Health. Washington: American Psychological Association.

Summerfield, Arthur 1958 Clinical Psychology in Britain. American Psychologist 13:171–176.

CLINICAL SOCIOLOGY

Clinical sociology is a humanistic, multidisciplinary specialization that seeks to improve the quality of people's lives. Clinical sociologists assess situations and reduce problems through analysis and intervention. Clinical analysis is the critical assessment of beliefs, policies, and/or practices with an interest in improving a situation. Intervention, the creation of new systems as well as the change of existing systems, is based on continuing analysis.

Clinical sociologists have different areas of expertise—such as health promotion, sustainable communities, social conflict, or cultural competence—and work in many capacities. They are, for example, community organizers, sociotherapists, mediators, focus group facilitators, social policy implementers, action researchers, and administrators. Many clinical sociologists are full-time or part-time university professors, and these clinical sociologists undertake intervention work in addition to their teaching and research.

The role of the clinical sociologist can be at one or more levels of focus from the individual to the intersocietal. Even though the clinical sociologist specializes in one or two levels of intervention (e.g., marriage counseling, community consulting), the practitioner will move among a number of levels (e.g., individual, organization, community) in order to analyze or intervene or both.

THE HISTORY OF AMERICAN CLINICAL SOCIOLOGY

When sociology emerged as a discipline in the 1890s, the nation was struggling with issues of democracy and social justice. There was rural and urban poverty, women were still without the vote, and there were lynchings. Farmers and workers in the late 1800s were frustrated because they could see the centralization of economic and political power in the hands of limited groups of people. This kind of frustration led to public protests and the development of reform organizations. In this climate, it is not surprising that many of the early sociologists were scholar-practitioners interested in reducing or solving the pressing social problems that confronted their communities.

The First University Courses . While many of the early sociologists were interested in practice, the earliest known proposal using the words "clinical sociology" was by Milton C. Winternitz (1885–1959), a physician who was dean of the Yale School of Medicine from 1920 through 1935. At least as early as 1929, Winternitz began developing a plan to establish a department of clinical sociology within Yale's medical school. Winternitz wanted each medical student to have a chance to analyze cases based on a medical specialty as well as a specialty in clinical sociology.

Winternitz vigorously sought financial support for his proposal from the Rosenwald Fund, but he was unable to obtain the necessary funds for a department of clinical sociology. He did note, however, the success of a course in the medical school's section on public health that was based on the clinical sociology plan.

The first course using the words "clinical sociology" in the title was taught by Ernest W. Burgess (1886–1966) at the University of Chicago. Burgess taught the course in 1928 and then offered it twice in 1929. During these years, the course was considered to be a "special" course and did not appear in the university's catalog. Burgess offered the clinical sociology course, as a regular course, five times from 1931 through 1933. The course continued to be listed in the catalog for the next several years but was not taught after 1933.

The University of Chicago catalogs did not include a description of the clincal sociology course, but the course always was listed under the social pathology grouping. All courses in this section dealt with topics such as criminality, punishment, criminal law, organized crime, and personal disorganization. Several of the students enrolled in these first clinical sociology courses were placed in child guidance clinics. Clarence E. Glick, for instance, was the staff sociologist at Chicago's Lower North Side Child Guidance Clinic and Leonard Cottrell was the clinical sociologist at the South Side Child Guidance Clinic.

Two other universities offered clinical courses in the l930s—Tulane University in Louisiana and New York University. The Tulane University course was designed to give students the opportunity to learn about behavior problems and social therapy by conferences and fieldwork in a child guidance clinic. Louis Wirth (1897–1952), a full-time faculty member and director of the New Orleans Child Guidance Clinic, was scheduled to teach the course in the spring of 1930. Wirth was unable to teach the course because he accepted a one-year Social Science Research Council Fellowship to work in Europe. The course was taught in his absence, but the university's course information does not identify the professor who took Wirth's place.

When Wirth returned to the United States in 1931, he joined the faculty of the University of Chicago. In the spring of 1932 he taught a "minor" course in clinical sociology but by then he no longer was working with child guidance clinics.

New York University also offered clinical sociology courses in the early 1930s. Harvey Warren Zorbaugh (1896–1965) was a faculty member there in the School of Education which provided undergraduate and graduate preparation for visiting teachers, educational counselors, clinicians, social workers, and school guidance administrators. The major focus of the program was the solution of educational problems and other social dilemmas.

Zorbaugh, along with Agnes Conklin, offered "Seminar in Clinical Practice" in 1930. The course was intended to qualify students as counselors or advisers to deal with behavioral difficulties in schools. From 1931 through 1933 the clinical practice course was called "Seminar in Clinical Sociology." The course was one of the highest numbered courses in educational sociology and was offered both terms of each year. The course was open to graduate students who were writing theses or engaged in research projects in the fields of educational guidance and social work.

Zorbaugh, author of The Gold Coast and the Slum: A Sociological Study of Chicago's Near North Side, had been involved with clinics at least since 1924. That was the year Zorbaugh and Clifford Shaw organized two sociological clinics in Chicago—the Lower North and South Side Child Guidance Clinics. Zorbaugh was associate director of the Lower North Side Child Guidance Clinic in 1925.

Zorbaugh was a founder, in 1928, of the Clinic for the Social Adjustment of the Gifted at New York University. He was director of this clinic at its inception and was actively involved in its work for over fifteen years. The clinic was for intellectually gifted and talented preadolescents. The clinic gave graduate students the opportunity to have supervised experiences in teaching, clinical diagnosing and treating of children with behavioral problems.

During the 1953–54 academic year, Alvin W. Gouldner (1920–1980) was teaching in the Department of Sociology and Anthropology at Antioch College in Ohio. Before joining the faculty, Gouldner had been a university teacher for four years and then worked, for one year, as a consultant to Standard Oil of New Jersey.

Gouldner offered "Foundations of Clinical Sociology" at Antioch. The course was taught at the highest undergraduate level, and students who enrolled in the course were expected to have completed the department's course in social pathology. The college bulletin provided the following description of the course:

A sociological counterpart to clinical psychology with the group as the unit of diagnosis and therapy. Emphasis on developing skills useful in the diagnosis and therapy of group tenstions. Principles of functional analysis, group dynamics, and organizational and small group analysis examined and applied to case histories. Representative research in the area assessed.

The term "clinical sociology" first appears in print . The first known published linking of the words clinical and sociology was in 1930 when Milton C. Winternitz, a pathologist and dean of the Yale Medical School, wanted to establish a department of clinical sociology. After working on the idea at least as early as 1929, he wrote about it in a report to the president of the Yale Medical School and the report was published in the 1930 Yale University Bulletin. That same year saw the publication of a speech Winternitz had given at the dedication of the University of Chicago's new social science building. The speech also mentioned clinical sociology.

Abraham Flexner, a prominent critic of medical education and director of the Institute for Advanced Study at Princeton, mentioned clinical sociology in 1930 in his Universities: American, English, German. Flexner did not approve of the Institute of Human Relations that Winternitz was establishing at Yale. In the pages of criticism devoted to the institute, Flexner briefly mentioned clinical sociology: "Only one apparent novelty is proposed: a professor of clinical sociology" (Flexner 1930).

Winternitz continued to write about the value of clinical sociology until 1936 when his last report as dean was filed. One of Winternitz's (1932) most forceful statements in support of the field was the contemporary-sounding statement that appeared in his 1930–1931 annual report:

The field for clinical sociology does not seem by any means to be confined to medicine. Within the year it has become more and more evident that a similar development may well be the means of bringing about aid so sorely needed to change the basis of court action in relation to crime. . .

Not only in medicine and in law, but probably in many other fields of activity, the broad preparation of the clinical sociologist is essential. . .

The first discussion of clinical sociology by a sociologist was Louis Wirth's 1931 article, "Clinical Sociology," in The American Journal of Sociology. Wirth wrote at length about the possibility of sociologists working in child development clinics, though he did not specifically mention his own clinical work in New Orleans. Wirth wrote "it may not be an exaggeration of the facts to speak of the genesis of a new division of sociology in the form of clinical sociology" (Wirth 1930).

In 1931, Wirth also wrote a career development pamphlet, which stated:

The various activities that have grown up around child-guidance clinics, penal and correctional institutions, the courts, police systems, and similar facilities designed to deal with problems of misconduct have increasingly turned to sociologists to become members of their professional staffs (Wirth 1931).

Wirth "urged (sociology students) to become specialists in one of the major divisions of sociology, such as social psychology, urban sociology. . . or clinical sociology" (Wirth 1931).

In 1931, Saul Alinsky was a University of Chicago student who was enrolled in Burgess's clinical sociology course. Three years later, Alinsky's article, "A Sociological Technique in Clinical Criminology," appeared in the Proceedings of the Sixty-Fourth Annual Congress of the American Prison Association. Alinsky, best known now for his work in community organizing, was, in 1934, a staff sociologist and member of the classification board of the Illinois State Penitentiary.

In 1944 the first formal definition of clinical sociology appeared in H.P. Fairchild's Dictionary of Sociology. Alfred McClung Lee, the author of that definition, was known as one of the founders of the Society for the Study of Social Problems, the Association for Humanist Sociology, and the Sociological Practice Association. Lee later used the word "clinical" in the title of two articles—his 1945 "Analysis of Propaganda: A Clinical Summary" and the 1955 article "The Clinical Study of Society."

Also appearing in 1944 was Edward McDonagh's "An Approach to Clinical Sociology." McDonagh had read Lee's definition of clinical sociology but had not seen Wirth's 1931 article. McDonagh, in his Sociology and Social Research article, proposed establishing social research clinics that had "a group way of studying and solving problems" (McDonagh 1944).

In 1946 George Edmund Haynes's "Clinical Methods in Interracial and Intercultural Relations" appeared in The Journal of Educational Sociology. Haynes was a cofounder of the National Urban League (1910) and the first African American to hold a U.S. government subcabinet post. His 1946 article, written while he was executive secretary of the Department of Race Relations at the Federal Council of the Churches of Christ in America, discussed the department's urban clinics. The clinics were designed to deal with interracial tensions and conflicts by developing limited, concrete programs of action.

Contemporary contributions . While publications mentioning clinical sociology appeared at least every few years after the 1930s, the number of publications increased substantially after the founding of the Clinical Sociology Association in 1978. The association, now called the Sociological Practice Association, made publications a high priority. Individuals were encouraged to publish and identify their work as clinical sociology, and the association established publication possibilities for its members. The Clinical Sociology Review and the theme journal Sociological Practice were published by the association beginning in the early 1980s. These annual journals were replaced in the 1990's by Sociological Practice: A Journal of Clinical and Applied Sociology, a quarterly publication.

The Sociological Practice Association has had a central role in the development of American clinical sociology. The association helped make available the world's most extensive collection of teaching, research, and intervention literature under the label of clinical sociology and it introduced the only clinical sociology certification process.

The Sociological Practice Association's rigorous certification process for clinical sociologists is available at the Ph.D. and M.A. levels. The Ph.D.-level process was adopted in l983 and certification was first awarded in 1984. The association began to offer M.A.-level certification in 1986. Successful candidates at both the doctoral and master's level are awarded the same designation—C.C.S. (Certified Clinical Sociologist).

Experienced clinical sociologists are encouraged to apply for certification. which is given for intervention work (assessing and changing social systems). As part of the application process, a candidate is required to identify her or his area of specialization (e.g., community, family counseling) and level of intervention (e.g., organization, individual). The certification process requires membership in the Sociological Practice Association, documentation of appropriate education and supervised training, documentation of interdisciplinary training, essays about ethics and theory, and a demonstration before peers and a reviewing committee.

The Sociological Practice Association, along with the Society for Applied Sociology, also has put in place a Commission on Applied and Clinical Sociology. The commission has set standards for the accreditation of clinical and applied sociology programs at the baccalaureate level and intends to do the same for graduate programs.

CLINICAL SOCIOLOGY AND SOCIOLOGICAL PRACTICE

The practical sociology of the l890s and early 1900s is now referred to as sociological practice. This general term sociological practice involves two areas, clinical sociology and applied sociology. Clinical sociology emphasizes hands-on intervention while applied sociology emphasizes research for practical purposes. Both specialties require different kinds of specialized training.

Some sociological practitioners are "clinical" in that they only or primarily do intervention work; others are "applied" in that they only or primarily conduct research that is of practical interest. Some practitioners do both. Clinical sociologists, for instance, may conduct research before beginning an intervention project to assess the existing state of affairs, during an intervention (e.g., to study the process of adaptation), and/or after the completion of the intervention to evaluate the outcome of that intervention. For some clinical sociologists, the research activity is an important part of their own clinical work. These sociologists have appropriate research training and look for opportunities to conduct research. Other clinical sociologists prefer to concentrate on the interventions and leave any research to other team members. Those clinical sociologists who decide not to engage in research may have research skills but prefer to conduct interventions, may not have enough expertise in the conduct of research, or may know that other team members have more expertise in research.

THEORIES, METHODS, AND INTERVENTION STRATEGIES

Clinical sociologists are expected to have education and training in at least one area in addition to sociology. This means that not only are clinical sociologists exposed to the range of theories (e.g., symbolic interaction, structural-functionalism, conflict, social exchange) and quantitative and qualitative research methods generally taught in sociology programs, but they also have additional influences from outside of their own programs. The result is that clinical sociologists integrate and use a broad range of theoretical and methodological approaches.

Clinical sociologists use existing theory to formulate models that will be helpful in identifying and understanding problems and also to identify strategies to reduce or solve these problems. Clinical sociologists also have shown that practice can have an influence on existing theories and help in the development of new ones.

While clinical sociologists use a wide variety of research methods and techniques (e.g., participatory action research, geographic information systems, focus group analysis, surveys), they probably are best known for their case studies. Case studies involve systematically assembling and analyzing detailed, in-depth information about a person, place, event, or group. This methodological approach involves many data-gathering techniques such as document analysis, life histories, in-depth interviews, and participant observation.

Clinical sociologists who have been in the field for ten or twenty years probably learned about intervention strategies primarily through courses and workshops given outside of sociology departments as well as through their work and community experiences. Clinical sociologists who have more recently entered the field also may have learned intervention techniques as part of their sociology programs. These sociology programs might include courses, for instance, on focus groups, mediation, or administration, as well as require supervised residencies or internships.

CLINICAL SOCIOLOGY IN INTERNATIONAL SETTINGS

Clinical sociology is as old as the field of sociology and its roots are found in many parts of the world. The clinical sociology specialization, for instance, often is traced back to the fourteenth-century work of the Arab scholar and statesperson Abd-al-Rahman ibn Khaldun (1332–1406). Ibn Khaldun provided numerous clinical observations based on his varied work experiences such as Secretary of State to the rule of Morocco and Chief Judge of Egypt.

Auguste Comte (1798–1857) and Emile Durkheim (1858–1917) are among those whose work frequently is mentioned as precursors to the field. Comte, the French scholar who coined the term "sociology", believed that the scientific study of societies would provide the basis for social action. Emile Durkheim's work on the relation between levels of influence (e.g., social compared to individual factors) led Alvin Gouldner (1965, p.19) to write that "more than any other classical sociologist (he) used a clinical model."

Interest in clinical sociology has been growing in a number of countries. For example, French is the predominant language of many, if not most, of the current international clinical sociology conferences, and books and articles have appeared with clinical sociology in the title in France and French-speaking Canada. The French-language clinical sociologists emphasize clinical analysis. They have a solid international network and have done an excellent job of attracting nonsociologists to that network. Their literature is substantial. Particularly notable is the work of Jacques van Bockstaele and Maria van Bockstaele; Robert Sevigny, Eugene Enriquez, Vincent de Gaulejac, and Jacques Rheaume.

Beginning in the mid-1990's, Italians hosted clinical sociology conferences, published clinical sociology books and articles and ran numerous clinical sociology training workshops. If one is interested in learning about clinical sociology in Italy, one would want to review the work of Michelina Tosi, Francesco Battisti, and Lucio Luison. Luison's 1998 book, Introduczione alla Sociologia clinica (Introduction to Clinical Sociology), contains thirteen articles written by Americans. One is an original article written for the volume but all the others are translations of articles that appeared in the Sociological Practice Association's Clinical Sociology Review or Sociological Practice. The volume concludes with the Sociological Practice Association's code of ethics.

Clinical sociology also is found in other parts of the world. Of particular interest would be developments in Greece, Brazil, Mexico, Uruguay, and South Africa. In South Africa, for instance, one university's sociology department has put a sociological clinic in place and another sociology department has developed a graduate specialization in counseling.

The international development of clinical sociology has been supported primarily by two organizations. The clinical sociology division of the International Sociological Association (ISA) was organized in 1982 at the ISA World Congress in Mexico City. The other major influence is the clinical sociology section of the Association internationale des Sociologues de Langue Francaise (International Association of French Language Sociologists).

It is clear that a global clinical sociology is beginning to emerge. American clinical sociology had a strong role in the early development of the global specialization but now it is only one of many influences. It will be interesting to see if the thrust of the international field will be as explicitly humanistic and intervention-oriented as American clinical sociology.

references

Bruhn, John G., and Howard M. Rebach 1996 Clinical Sociology: An Agenda for Action. New York: Plenum.

Clark, Elizabeth J., Jan Marie Fritz, and P.P. Rieker (eds.) 1990 Clinical Sociological Perspectives on Illness & Loss: The Linkage of Theory and Practice. Philadelphia: The Charles Press.

Enriquez, Eugene 1997 "The Clinical Approach: Genesis and Development in Western Europe." International Sociology. 12/2(June):151–164.

——1992 "Remarques Terminales Vers une Sociologie Clinique d'Inspiration Psychanalytique." L'Organisation en Analyse. Fevrier. Paris: P.U.F.

——, Gilles Houle, Jacques Rheaume, and Robert Sevigny (eds.) 1993 L'Analyse Clinique dans les Sciences Humaines. Montreal: Editions Saint-Martin.

Fritz, Jan Marie (ed.) 1996 The Clinical Sociology Resource Book. 4th ed. Washington, D.C.: American Sociological Association Teaching Resources Center and the Sociological Practice Association.

Fritz, Jan Marie 1991a "The History of American Clinical Sociology: The First Courses." Clinical Sociology Review 9:5–26.

Fritz, Jan Marie 1991b "The Emergence of American Clinical Sociology." Pp. 17–32 In H. Rebach and J. Bruhn, eds., Handbook of Clinical Sociology. New York: Plenum.

Fritz, Jan Marie1985 The Clinical Sociology Handbook. New York: Garland.

Gaulejac, Vincent de and Shirley Roy (ed.), 1993 Sociologies Cliniques. Paris: Hommes et Perspectives.

Giorgino, Enzo 1998 "Per un Ridefinizione del Lavoro Professionale in Sociologia." Sociologia e Professione. 29 (Marzo):8–23.

Glassner, Barry, and Jonathan A. Freedman 1979 Clinical Sociology. New York: Longman.

Gouldner, Alvin 1965 "Explorations in Applied Social Science." Social Problems. 3/3(January):169–181. Reprinted 1965 in Alvin Gouldner and S.M. Miller, eds., Applied Sociology. 5–22 New York: Free Press.

Luison, Lucio (ed.) 1998 Introduczione alla Sociologia Clinica: Teorie, Metodi e Tecniche di Intervento. Milano: FrancoAngeli.

Rebach, Howard M., and John G. Bruhn (eds.), 1991 Handbook of Clinical Sociology. New York: Plenum

Rheaume, Jacques 1997 "The Project of Clinical Sociology in Quebec." International Sociology. 12/2(June):165–174.

Sevigny, Robert 1997 "The Clinical Approach in the Social Sciences." International Sociology. 12/2(June):135–150.

Straus, Roger A. (ed.), 1999 Using Sociology: An Introduction from the Applied and Clinical Perspectives. Third edition. New York: General Hall.

Straus, Roger A. (ed.), 1979 "Special Issue on Clinical Sociology." The American Behavioral Scientist. March/April.

Tosi, Michelina, and Francesco Battisti (eds.) 1995 Sociologia Clinica e Sistemi Socio-Sanitari: Dalle Premesse Epistemologiche Allo Studio di Casi e Interventi. Milano: FrancoAngeli.

van Bockstaele, Jacques, Maria van Bockstaele, Colette Barrot, and Cl. Magny 1963 "Travaux de Sociologie Clinique: Quelques Conditions d'une Intervention de Type Analytique en Sociologie." L'Annee Sociologique. Paris: Presses Universitaires de France.

van Bockstaele, Jacques, Maria van Bockstaele, Colette Barrot, Jacques Malbos, and Pierrette Schein 1968 "Problemes de la Sociologie Clinique: Nouvelles Observations sur la Definition de la Socioanalyse." L'Annee Sociologique. Paris: Presses Universitaires de France.

Winternitz, Milton Charles 1932 "Clincal Sociology." In Report of the dean of the School of Medicine, Bulletin of Yale University.

Wirth, Louis 1931a "Clinical Sociology." American Journal of Sociology, 37:49–66.

——1931b Sociology: Vocations for those Interested in It. Pamphlet.Vocational Guidance Series, No. l. Chicago: University of Chicago. Louis Wirth Collection, University of Chicago, Department of Special Collections. Box LVI, Folder 6.

Jan Marie Fritz

PSYCHOLOGY, HEALTH

Psychology has various definitions, most of them stating that psychology is the study of behavior. Health psychology is the application of psychology to health-related problems and behavior. Most psychological applications in health are from the discipline of social psychology. The contribution of health psychology to public health is in such areas as psychological processes in prevention, health maintenance (e.g., not smoking), and patient education, particularly in helping people cope with an illness (e.g., mastering the use of the peak flow meter to control asthma).

HEALTH PSYCHOLOGY PERSPECTIVES

Health psychology deals with individual behavior in a social context. However, within the public health sector, behavior is not restricted to behavior of at-risk persons, but also includes behaviors of peers, parents, health professionals, employers, politicians, and others. Unfortunately, while there is a large amount of empirical data available regarding individual behavior of the at-risk person or patient, there is very little data available about behaviors at other social levels.

Health psychologists try to understand behavior by describing psychosocial determinants for individual behavior. But health psychologists also try to understand and promote behavior change. One basic assumption in health psychology is that to change people's behavior—at least through health promotion interventions—it is necessary to understand the psychosocial determinants of behavior. For example, when a smoker fails to stop smoking because of a lack of motivation, another type of intervention is required than for a smoker that fails because of a lack of social support.

The first public health applications of psychology were strongly focused on risk perception and risk taking. The best example may be the health belief model, where the perception of the severity of the risk and the susceptibility for the risk were seen as the primary determinants of health-protective behaviors. Over time, it became clear that people have many reasons for health-related behaviors, of which risk perception is often not an important one. In this multicausality approach, there is also a growing recognition of the many psychosocial and environmental influences on individual behavior. Changes in psychosocial determinants (e.g., self-efficacy) are most effective in creating behavior change when paralleled by changes in the social and physical environment(e.g., removal of barriers).

The application of psychological theories to public health is not without debate. Some professionals state that psychological theories will never be able to fully help us understand behavior and behavior change; other professionals claim that in practice there is nothing so helpful as a good theory. Both perspectives are justified. Theories are, by definition, a reduction of reality, but they do help people organize their thoughts and ask the right questions. The interesting contribution of theories is that they can generalize findings from one area of behavior to be of use in another.

PSYCHOSOCIAL DETERMINANTS OF BEHAVIOR

The most often applied theories to explain the psychosocial determinants of behavior are Icek Ajzen's theory of planned behavior and Albert Bandura's social cognitive theory. Social cognitive theory (SCT) specifies the following determinants of behavior: outcome expectations, self-efficacy expectations, behavioral capability, perceived behavior of others (modeling), and the social and physical environment.

The theory of planned behavior (TPB) is an extension of the earlier theory of reasoned action. TPB postulates that intention, the most proximal determinant of behavior, is determined by three conceptually independent constructs: attitude, subjective norms, and perceived behavioral control (or self-efficacy). The attitude towards the behavior is determined by salient beliefs, or outcome expectations, about that behavior. Beliefs are weighted by evaluations or judgments about the value or importance of the expected outcome. For example, the expected outcome of going on a lowfat diet might be a lowering of blood pressure, which could be judged to be important and worthwhile.

Subjective norms, or perceived social expectations, are beliefs that specific, important individuals or groups approve or disapprove of the behavior. These beliefs are weighted by the motivation to comply with the referent person or group—that is, how important is a friend's or group's approval or opinion. Note that Ajzen's perceived social expectations are different from Bandura's perceived behavior of others, where the social environment does not necessarily expect certain behavior. Other authors have broadened the TPB social influence construct to include perceived behavior of others, perceived expectations of others, social pressure, and social support.

Perceived behavior control or self-efficacy refers to the subjective probability that a person is capable of executing a certain action (e.g., going on a low-fat diet might be perceived to be difficult).

Since the theory of planned behavior was introduced in the 1980s, other determinants have been suggested, including: personal moral norms, anticipated regret, identity concerns, and self-evaluation. Another development is an increasing attention to the relation between intentions and behavior. Studies on implementation intention show that helping people to make plans to behave in a certain way can improve the intention-behavior link. Intentions, however, may be overruled by habits. Behaviors become habitual when performed frequently and when performed in a stable environment. Under conditions where habits conflict with intentions, intentions become poor predictors of behavior. It is possible, however, to break bad habits by replacing a habitual sequence with an alternative sequence.

TPB is most often applied at the individual level. However, it has been applied to higher ecological levels as well, such as the voting behavior of legislators regarding a cigarette tax increase, or the adoption behavior of schoolteachers and principles for HIV (human immunodeficiency virus) prevention programs.

THE PSYCHOLOGY OF BEHAVIOR CHANGE

The most prominent psychology theories of behavior change are the social cognitive theory, James Prochaska and Carlo DiClemente's transtheoretical model, Richard Petty and John Cacioppo's elaboration likelihood model, and various theories on coping and self-regulation by authors like Richard Lazarus. Social cognitive theory suggests the following methods for change: active learning, reinforcement, and modeling and guided practice (including feedback).

The transtheoretical model (TTM) has two major sets of constructs: stages of change and processes of change. In the stages of change, people are thought to move from a state of no motivation to change to one of internalization of new behavior. The first stage is "precontemplation," in which people have no intention to change their behavior. In a successful change process, people make a transition to "contemplation," in which they are thinking about changing the problem behavior. Ideally, people then move to "preparation," in which they are planning to change this behavior in the short term. People who have recently changed their behavior are in the "action stage," whereas people who have performed the behavior for a longer time are in the "maintenance stage." People in the action stage may lapse and then recycle to an earlier stage.

TTM can be used to describe and to change behavior. An important contribution of the model is the specific tailoring of educational efforts to include different models and processes of change for individuals in different stages of change. For instance, a re-evaluation of outcome expectations is used to make the change from precontemplation to contemplation; and a guided practice for skills improvement can help with the change from action to maintenance.

Social psychology has a long tradition in persuasion research. Petty and Cacioppo have a new perspective on persuasion effects with their elaboration likelihood model (ELM). The basic idea of ELM is that people differ in their ability and motivation for thoughtful information processing of persuasive messages. These authors explain two ways of information processing, central or peripheral (also called systematic versus heuristic). Central processing occurs when a message is carefully considered and compared against other messages and beliefs. Peripheral processing occurs when a message is processed without thoughtful consideration or comparison. A variable—for instance, the credibility of a sports hero as a model—may have a positive effect when the receivers process the message through the peripheral route, but a negative effect when they follow the central route, because people might realize that their behavioral capabilities are different from those of the sports hero. Research findings suggest that thoughtful information processing is related to a higher persistence of attitude change, a higher resistance to counter-persuasion, and a stronger attitudebehavior consistency. ELM suggests two ways to stimulate central processing: Make the message more personally relevant and unexpected, and repeat the message.

Self-regulatory or self-management conceptualizations, including coping theories, have to do with how individuals function to behaviorally self-correct. Various authors describe this process. The general procedure is: (a) monitoring of some aspect of behavior or health, (b) comparing one's observation with normal or desired outcomes or behavior, describing a problem or divergence from normal, and analyzing the causes of the problem, and (c) trying a behavioral correction. This entire process recycles with a return to monitoring. Self-regulatory theories are useful for the designation of health-promoting behaviors for the self-management of chronic diseases, such as asthma, diabetes, or cystic fibrosis.

Gerjo Kok

(see also: Attitudes; Behavior, Health-Related; Health Belief Model; Social Cognitive Theory; Social Determinants; Theory of Planned Behavior; Transtheoretical Model of Stages of Change )

Bibliography

Abraham, C.; Sheeran, P.; and Johnston, M. (1998).

"From Health Beliefs to Self-Regulation: Theoretical Advances in the Psychology of Action Control." Psychology and Health 13:569–591.

Ajzen, I. (1991). "The Theory of Planned Behavior." Organizational Behavior and Human Decision Processes 50:179–211.

Ajzen, I., and Fishbein, M. (2000) "Attitudes and the Attitude-Behavior Relation: Reasoned and Automatic Processes." In European Review of Social Psychology, eds. W. Strebe and M. Hewstone. New York: Wiley.

Connor, M., and Norman, P., eds. (1996). Predicting Health Behavior: Research and Practice with Social Cognition Models. Buckingham, UK: Open University Press.

Glanz, K.; Lewis, F. M.; and Rimer, B. K., eds. (1997). Health Behavior and Health Education: Theory, Research, and Practice, 2nd edition. San Francisco: Jossey-Bass.

Kok, G.; Schaalma, H.; De Vries, H.; Parcel, G.; and Paulussen, T. H. (1996). "Social Psychology and Health Education." In European Review of Social Psychology, Vol. 7, eds. W. Strebe and M. Hewstone. New York: Wiley.

Lazarus, R. S. (1993). "Coping Theory and Research:

Past, Present, and Future." Psychosomatic Medicine 55:234–247.

Petty, R. E., and Wegener, D. T. (1997). "Attitude Change: Multiple Roles for Persuasion Variables." In The Handbook of Social Psychology, 4th edition, Vol. 1, eds. D. T. Gilbert, S. T. Fiske, and G. Lindsey. Boston: McGraw-Hill.

Stroebe, W. (2000). Social Psychology and Health, 2nd edition. Buckingham, UK: Open University Press.

Taylor, S. E. (1995). Health Psychology, 3rd edition. New York: McGraw-Hill.

Clinical psychology

The application of psychological principles to diagnosing and treating persons with emotional and behavioral problems.

Clinical psychologists apply research findings in the fields of mental and physical health to explain dysfunctional behavior in terms of normal processes. The problems they address are diverse and include mental illness , mental retardation , marital and family issues, criminal behavior, and chemical dependency. The clinical psychologist may also address less serious problems of adjustment similar to those encountered by the counseling psychologist.

Approximately one-third of the psychologists working in the United States today are clinical psychologists. A number of clinical psychologists are in private practice, either alone or in group practice with other mental health professionals. Others may practice in a variety of settings, including community mental-health centers, university medical schools, social work departments, centers for the mentally and physically handicapped, prisons, state institutions and hospitals, juvenile courts, and probation offices. Clinical psychologists use psychological assessment and other means to diagnose psychological disorders and may apply psychotherapy to treat clients individually or in groups. In the United States, they are governed by a code of professional practice drawn up by the American Psychological Association .

Individuals consult clinical psychologists for treatment when their behaviors or attitudes are harmful to themselves or others. Many different treatment types and methods are employed by psychologists, depending on the setting in which they work and their theoretical orientation. The major types of therapy include psychodynamic therapies, based on uncovering unconscious processes and motivations, of which the most well known is Freudian psychoanalysis ; phenomenological, or humanistic, therapies (including the Rogerian and Gestalt methods) which view psychotherapy as an encounter between equals, abandoning the traditional doctor-patient relationship; and behavior-oriented therapies geared toward helping clients see their problems as learned behaviors that can be modified without looking for unconscious motivations or hidden meanings. These therapies, derived from the work of Ivan Pavlov and B.F. Skinner , include methods such as behavior modification and cognitive-behavior therapy, which may be used to alter not only overt behavior but also the thought patterns that drive it.

The work of the clinical psychologist is often compared with that of the psychiatrist, and although there is overlap in what these professionals do, there are also specific distinctions between them. As of 1996, clinical psychologists cannot prescribe drugs to treat psychological disorders, and must work in conjunction with a psychiatrist or other M.D. who is authorized to administer controlled substances. However, a movement is under-way for prescription privileges for psychologists. The clinical psychologist has extensive training in research methods and in techniques for diagnosing, treating, and preventing various disorders. Most psychologists earn a Ph.D. degree in the field, which requires completion of a four- to six-year program offered by a university psychology department. The course of study includes a broad overview of the field (including courses in such areas as statistics, personality theory, and psychotherapy), as well as specialization in a particular subfield and completion of a practicum, internship, and dissertation.

A new training program for psychologists was developed and introduced at the University of Illinois, which offered the first Psychology Doctorate (Psy.D.) in 1968. This degree program is geared exclusively toward the training of clinicians rather than researchers. It stresses course work in applied methods of assessment and intervention and eliminates the dissertation requirement. The number of Psy.D. programs in the United States has grown since 1968, with some programs offered at universities and others at independent, "freestanding" professional schools of psychology.

Assessment plays a prominent role among the functions of clinical psychology. The term "clinical psychology" itself was first used at the end of the nineteenth century in connection with the testing of mentally retarded and physically handicapped children. The discipline soon expanded with the growing interest in the application of assessment techniques to the general population following Robert Yerkes's revision of the Stanford Binet Intelligence scales in 1915, creating a widely used point scale for the measurement of human mental ability . Clinical psychologists must be familiar with a variety of techniques of assessing patients through interviews, observation, tests, and various forms of play . Assessment may be used to compare an individual with others in a reliable way using standardized norms; determine the type and circumstances of symptomatic behaviors; understand how a person functions in a given area (cognition , social skills, emotion ); or match a patient to a particular diagnostic category for further treatment.

While the clinical psychologist does not specialize in research, the two disciplines often overlap. With their varied experiences, clinicians are qualified to participate in research on, for example, cost effectiveness in health care, design of facilities, doctor-patient communication, or studies of various treatment methods. Clinical psychologists routinely contribute to the training of mental health professionals and those in other areas of health care, serving on the faculties of universities and independent institutes of psychology, where they teach courses, supervise practicums and internships, and oversee dissertation research. They also carry out administrative appointments which call for them to assist in the planning and implementation of health care services and are represented in international groups such as the World Health Organization.

Further Reading

Bernstein, Douglas A. Introduction to Clinical Psychology. New York: McGraw-Hill, 1980.

Lilienfeld, Scott O. Seeing Both Sides: Classic Controversies in Abnormal Psychology. Pacific Grove, CA: Brooks/Cole, 1995.

Nietzel, Michael T. Introduction to Clinical Psychology. 3rd ed. Englewood Cliffs, NJ: Prentice Hall, 1991.

Health psychology

A subfield of psychology devoted to health maintenance, including research on the relationship between mental and physical health, guidance in improving individual health through lifestyle changes, and analysis and improvement of the health care system.

Health psychology is a diverse area with a variety of emphases. Medical psychology focuses on the clinical treatment of patients with physical illnesses, offering practical advice people can use in order to improve their health. While there is special emphasis on psychosomatic disorders—those that have traditionally been most closely related to psychological factors—the current trend is toward a holistic perspective that considers all physical health inseparable from a patient's emotional state. As part of this trend, psychologists and pediatricians have joined forces in the growing area of pediatric psychology, collaborating to meet the health and developmental needs of children and their families. Another focal point is rehabilitation psychology, which teams mental health professionals with health care providers who care for patients with physical disabilities and chronic conditions, often in institutional settings.

Another province of health psychology is the study of "health behavior"—how people take care of or neglect their health, either in a preventative context or when they are ill. This area includes such concerns as drug abuse, utilization of health care resources, and adjustment to chronic illness. Health psychology also addresses the health care system itself, including analysis of the outreach, diagnostic, and prescription processes, provider-patient interaction, and the training of health care personnel.

See also Applied psychology